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Delirium: behavioural changes before and during the prodromal phase
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Vårdforskning Medicin)
2004 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, no 5, 609-616 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Delirium is an important form of psychopathology in older people and is associated with increased morbidity and functional decline. In the prodromal phase of delirium early symptoms occur, before all criteria have been met.

AIM:

The aim of this study was to delineate behavioural changes before and during the prodromal phase of delirium. That was considered to include the time from the first behavioural change up to the point when all DSM-IV criteria for delirium were met.

DESIGN:

Prospective and descriptive observation study.

METHODS:

One hundred and three hip surgery patients (hip fracture and hip replacement) aged > or = 80 years participated in this study. On admission none of them was delirious or had severe cognitive decline, but 32 patients met the DSM-IV criteria for delirium during the hospital stay. Frequent observations were performed up to delirium onset or 48 hours postoperatively. The observations included 37 items on the patient's state of mind, cognition, activity and behaviour. The first observation on admission was used as a reference and behavioural changes were defined as deviations from this first observation.

RESULTS:

Twenty-one patients out of the 32 who met the DSM-IV criteria (62%, D group) demonstrated behavioural changes before delirium onset, as did 34 (48%, R group) out of the remaining 71 patients. The D group had different and more numerous behavioural changes than the R group. Anxiety was common in both groups. Disorientation and urgent calls for attention were the most frequent changes in the D group. The D group presented a pattern of behavioural changes and early symptoms of the approaching delirium. Six hours immediately before the onset of delirium, the behavioural changes were more numerous and evident.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE:

It is necessary to pay attention to each behavioural change in the patients and to be aware of the prodromal phase of delirium in order to prevent its onset and to maintain the patient's well-being.

Place, publisher, year, edition, pages
2004. Vol. 13, no 5, 609-616 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-91140DOI: 10.1111/j.1365-2702.2004.00898.xPubMedID: 15189414OAI: oai:DiVA.org:uu-91140DiVA: diva2:163758
Available from: 2003-11-18 Created: 2003-11-18 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Delirium during Hospitalisation: Incidence, Risk Factors, Early Signs and Patients' Experiences of Being Delirious
Open this publication in new window or tab >>Delirium during Hospitalisation: Incidence, Risk Factors, Early Signs and Patients' Experiences of Being Delirious
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Delirium is common among old patients admitted to hospital, but is often a neglected problem in patient care. The principal aim of this thesis was to evaluate aspects of delirium in relation to incidence, risk factors, behavioural changes, cognitive function and health-related quality of life (HRQOL). A further aim was to describe patients’ experiences of being delirious. The study was prospective, descriptive and comparative, with repeated measures (six-month follow up). The sample consisted of 225 consecutive patients, aged 65 years or older, who were to be operated on due to hip fracture or hip replacement. Exclusion criteria were serious cognitive disorder or delirium on admission. Data were collected via frequent daily observations, cognitive functioning tests (MMSE), HRQOL questionnaires (SF-36) and interviews. Delirium was assessed according to the DSM-IV criteria. A total of 45/225 became delirious, with an incidence of 24.3% among patients undergoing hip fracture surgery and 11.7% among those with hip replacement surgery. A predictive model for delirium included four factors: impaired hearing, passivity, low cognitive functioning, and waiting more than 18h for hip fracture surgery. Disorientation and urgent calls for attention were the most frequent behavioural changes in the prodromal phase prior to delirium. Delirium in connection with hip fracture revealed deteriorated HRQOL and cognitive functioning when measured at a six-month follow-up. The experience of being delirious was described by the patients as a sudden change of reality. Such an experience gave rise to strong emotional feelings, as did recovery from delirium. Nurses’ observations of behavioural changes in old patients with impaired cognitive function may be the first step in managing and reducing delirium. The predictive model of delirium ought to be tested further before use in clinical practice.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2003. 58 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1311
Keyword
Nursing, delirium, Acute confusional state, hip surgery, hip fracture, replacement surgery, cognitive function, MMSE, Follow-up, health-related quality of life, HRQOL, SF-36, Omvårdnad
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-3814 (URN)91-554-5820-3 (ISBN)
Public defence
2003-12-11, Föreläsningssal 6, Campus Lugnet, Högskolan Dalarna, Falun, 13:00
Opponent
Supervisors
Available from: 2003-11-18 Created: 2003-11-18Bibliographically approved

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